Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

420 IV. SPECIAL POPULATIONSand the course of disease. Attention to a wider range of immune measures otherthan CD4+ cells alone and more extensive psychosocial assessments havefound associations between specific stressors and depression and the course ofHIV (Burack et al., 1993; Cole, Kemeny, Taylor, Visscher, & Fahey, 1996;Evans et al., 1995; Goodkin et al., 1994).AIDS IN DRUG ADDICTION TREATMENTVigorous behavioral change strategies are required in the treatment of alcoholand drug abuse in those infected with or at risk for HIV infection. AIDS education,prevention, and behavioral training should be a regular and ongoing componentof drug treatment. Evaluators must use recognized general treatmentprinciples, such as those in the “Practice Guideline for Treatment of Patientswith Substance Use Disorders” (American Psychiatric Association, 1995) andwidely accepted placement criteria (American Society of Addiction Medicine,2003). Drug addiction is a chronic, relapsing disease and may require ongoingor repeated treatments. In one 12-year study, 29% of drug injectors remainedpersistent injectors and had the highest mortality rates (Galai, Safaeian,Vlahov, Bolotin, & Celentano, 2003). Overall care of those with HIV is likelyto be improved by integration of case management, medical, and substanceabuse treatment (Knowlton et al., 2001).BASIC COMPONENTS OF HIV/AIDS PREVENTION/TREATMENT IN DRUG ABUSE TREATMENT SETTINGSEffective management of these cases requires a multidisciplinary team that canimplement an individualized treatment plan structured to succeed within theconstraints of available resources and motivational forces:• Assessment of HIV risk behavior with frequent reassessments• Complete physical examination• Psychiatric assessment and indicated treatment• HIV testing• Safe sex training for all. This includes explicit discussion of proper use ofbarrier methods and techniques (latex condoms, gloves, and dentaldams), and stressing the importance of using barrier methods for all penetrativesexual practices or when body fluids are transmitted or exchanged(Centers for Disease Control and Prevention, 1993).Active alcohol and drug abusers encountered in any health care settingsshould be offered appropriate referrals and encouraged to enter treatment. Cul-